Subtipos "no clásicos" de diabetes mellitus

K, Verónica Raddatz; A, Pilar Durruty; B, Gloria Briones; S, Gloria López; Soto, Néstor; A, Manuel García de los Ríos

doi:10.4067/s0034-98872001000800003

Cited by 3 publications

(2 citation statements)

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“…En los últimos años se ha descrito la diabetes «atípica», que suele presentarse en adolescentes o adultos jóvenes, sin marcadores inmunológicos de DM tipo 1 y que debutan con cetoacidosis diabética grave. Contrariamente a lo ocurrido con nuestro caso, ellos responden a la insulina y son eficientemente manejados posteriormente con hipoglicemiantes orales 16 . Esta forma de diabetes se caracteriza por la insulinorresistencia y la hiposecreción de insulina.…”

Section: Tabla 2 Evolución De Glicemias Posalta En Relación a Dosisunclassified

Cetoacidosisdiabética reversible con metotrexato: Resistencia al tratamiento insulínico. Caso clínico

P³

et al. 2007

Rev. méd. Chile

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We report a 42 year-old woman with a hypothyroidism and a mixed connective tissue disease treated with prednisone and methotrexate. The patient had normal blood glucose levels but when the methotrexate dose was tapered, she presented a diabetic ketoacidosis that required up to 520 units of insulin per day. Due to the intensification of the mixed connective tissue disease symptoms, the doses of methotrexate and prednisone were increased again with a simultaneous normalization of serum glucose levels and glucose tolerance. In the following six months, when the dose of methotrexate was tapered again, the hyperglycemia reappeared and was again controlled increasing the dose. Thirty months after the episode of ketoacidosis, the patient was with a weekly dose of methotrexate, asymptomatic and with a normal glucose tolerance. Anti insulin antibodies were not detected and anti islet antibodies were indeterminate, due to interference with antinuclear antibodies. It is possible that the episode of ketoacidosis was unveiled by an autoimmune phenomenon.

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Section: Tabla 2 Evolución De Glicemias Posalta En Relación a Dosisunclassified

Cetoacidosisdiabética reversible con metotrexato: Resistencia al tratamiento insulínico. Caso clínico

P³

et al. 2007

Rev. méd. Chile

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“…These patients present diabetes at adulthood and usually do not require insulin therapy immediately after their diagnosis, as they present primarily with symptoms and signs of type 2 DM (T2DM) [3,4]. Diabetic ketoacidosis (DKA) most commonly appears as the first clinical presentation of T1DM [5], but as the first manifestation of LADA it is extremely rare, and very few cases have been described to date [6][7][8][9].…”

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Diabetic ketoacidosis as first presentation of latent autoimmune diabetes in adults in a patient with hashitoxicosis as first presentation of Hashimoto’s thyroiditis: a case report

Xenou

Zoupas

Lygnos³

et al. 2022

J Med Case Reports

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Background Latent autoimmune diabetes in adults is an infrequent form of autoimmune diabetes mellitus, while Hashimoto’s thyroiditis, the most common thyroid disease in adults, rarely manifests as thyrotoxicosis. The concurrent initial presentation of these two autoimmune disorders is extremely rare. Case presentation A 29-year-old male of Albanian descent presented after being hospitalized owing to diabetic ketoacidosis. The diagnosis of type 1 diabetes mellitus was placed, and intensified insulin therapy was initiated. Medical history was not of significance except a 5 kg weight loss within 2 months. The patient presented with recurrent episodes of hypoglycemia, and the doses of preprandial and basal insulin were reduced. The differential diagnosis included type 1 diabetes mellitus “honeymoon” period or another type of diabetes mellitus. His serological tests only revealed positive autoantibodies against glutamic acid decarboxylase 65 and C-peptide. The diagnosis leaned toward latent autoimmune diabetes in adults, and the therapeutic approach involved cessation of preprandial insulin therapy, regulation, and subsequent discontinuation of basal insulin and introduction of metformin. Two years later, basal insulin was reintroduced along with a glucagon-like peptide-receptor agonist and metformin. Further physical examination during the initial visit disclosed upper limb tremor, lid lag, excessive sweating, increased sensitivity to heat, and tachycardia. Laboratory tests were indicative of hashitoxicosis (suppressed level of thyroid-stimulating hormone, high levels of total and free thyroid hormones, positive anti-thyroglobulin and anti-thyroid peroxidase, and negative anti-thyroid-stimulating hormone receptor). Thyroid-stimulating hormone level was spontaneously restored, but an increase was observed during follow-up. Levothyroxine was administrated for 2 years until the patient had normal thyroid function. Conclusions The prevalence of thyroid autoantibodies in patients with latent autoimmune diabetes in adults ranges from 20% to 30%. This correlation can be attributed to genetic involvement as well as disorders of immune tolerance to autoantigens. Hence, this report gives prominence to the holistic approach and consideration of comorbidities in patients with diabetes mellitus.

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Diabetic Ketoacidosis as First Presentation of Latent Autoimmune Diabetes in Adult

Nadhem

Nakhla

Smalligan

2015

Case Reports in Medicine

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A 54-year-old white female with hypothyroidism presented with abdominal pain, nausea, vomiting, and diarrhea. She was found to have diabetic ketoacidosis (DKA) and admitted to our hospital for treatment. Laboratory workup revealed positive antiglutamic acid decarboxylase antibodies and subsequently she was diagnosed with latent onset autoimmune diabetes in adult (LADA). She was successfully treated with insulin with clinical and laboratory improvement. Diagnosis of LADA has been based on three criteria as given by The Immunology of Diabetes Society: (1) adult age of onset (>30 years of age); (2) presence of at least one circulating autoantibody (GADA/ICA/IAA/IA-2); and (3) initial insulin independence for the first six months. The importance of this case is the unlikely presentation of LADA. We believe that more research is needed to determine the exact proportion of LADA patients who first present with DKA, since similar cases have only been seen in case reports. Adult patients who are obese and have high blood sugar may deserve screening for LADA, especially in the presence of other autoimmune diseases. Those patients once diagnosed with LADA need extensive diabetic education including potentially serious events such as diabetic ketoacidosis.

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Subtipos "no clásicos" de diabetes mellitus

Cited by 3 publications

References 0 publications

Cetoacidosisdiabética reversible con metotrexato: Resistencia al tratamiento insulínico. Caso clínico

Cetoacidosisdiabética reversible con metotrexato: Resistencia al tratamiento insulínico. Caso clínico

Diabetic ketoacidosis as first presentation of latent autoimmune diabetes in adults in a patient with hashitoxicosis as first presentation of Hashimoto’s thyroiditis: a case report

Diabetic Ketoacidosis as First Presentation of Latent Autoimmune Diabetes in Adult

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